I’m an old dog. Been in practice for 25 years. I love my autonomy but I’m finding the market being carved up by those who are part of this group or that hospital. It’s becoming a bit Darwinian out here in the medical field. Sure, I have my sense of what is right for me. I’d like to just provide patient care and forget about the issue of money. But I realize that’s not reality.
So what do we do? How do we improve this bohemouth we call health care? Health care is a huge economic engine. Change it fast and we’ll be in another bail-out situation. Change it slowly and we’ll still have far too many folks uninsured.
The starting point is utilization of services. Providers provide and consumers consume health care services at a rate that is just absurd. It blows my mind to see how much unnecessary care is provided. But who’s going to say no.
Honestly, I am sitting on the edge of my chair to see what the Obama administration is going to propose.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
The claustrophobia associated with wearing a cast is real. I had one patient a few years back end up in the ER with symptoms of a heart attack only to realize that the symptoms were merely due to the claustrophobia produced by the hard cast.
Join us in The Foot Talk Forums for this discussion on cast-trophobia.
Jeff Oster, DPM
Medical Director
Myfootshop.com
I can’t recall the last metatarsal phalangeal joint (mpj) replacement that I’ve done in the past 25 years, but as the winds of fate blew…I had two this week. One was for a likely Freiberg’s infraction of the 3rd mpj and the other was post traumatic degeneration of the 2nd mpj following surgery.
Does implant arthroplasty work well for these cases? I can’t say that I really know. I have such a limited case load to be able to draw from. The basic premise though is to preserve the weight bearing surface of the metatarsal while creating a pain free joint.
The Freiberg’s case was really in need of repair. Upon entering the joint, a large loose fragment of bone and cartilage came loose.
We’ll have to see how these folks do over time. At their first post-op visit, I was very impressed with the lack of pain that they had. X-ray findings were good in both cases.
I reckon you’ll just have to stay tuned…
Jeff
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
With the advent of MRI, we now have a new category of bone injury called a bone contusion (also called bone swelling). Is a bone contusion really a fracture? I think so, but thus far, we don’t really have the vocabulary in the literature to call a bone contusion a fracture. Let me explain…
A contusion is a tern usually applied to soft tissue injuries that involve numerous structures. A contusion may involve nerve, subcutaneous tissue, tendon, etc. When we use the term contusion and refer to a bone injury, we’re describing a crush injury to the bone. Bone is usually made of a hard, outer surface with a softer, spongy inner surface. That softer, spongy surface acts as a shock absorber, absorbing load. But with a contusion, the hard, outer bone and the softer inner bone is crushed.
This is a hard injury for the bone to heal. And often, a hard choice for surgeons to try to rebuild. We drill it, graft it. But in most cases, the idea is to restore the bone to its’ normal load bearing structure.
So is a bone contusion really a fracture? I think so. Any thoughts?
Jeffrey Oster, DPM
Medical Director
Myfootshop.com
Fusion of the subtalar joint is a common procedure for subtalar joint arthritis, particularly, post traumatic arthritis. The most common reason for subtalar joint post traumatic arthritis is calcaneal (heel) fractures. Fractures of the calcaneus will often affect the subtalar joint resulting in progressive pain and arthritis.
Fusion of the subtalar joint is typically the procedure of choice. How will fusion of the subtalar joint affect activity levels and lifestyle? Join us in this conversation in The Foot Talk Forum for more information on subtalar joint fusions.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
